Advice on active B12 levels and symptoms please

[Piperh]

Hello

I’ve been suffering with many of the symptoms associated with anaemia for at least a year now (extreme tiredness, aches and pains, dizziness, nausea, tingling legs etc).

I’ve recently found out that my active b12 levels are slightly low: 34.7 pmol/l (reference range 37.5 - 188) but I’m not sure whether that’s low enough to cause symptoms and wondered whether anybody has experience of this test and the usual levels people with PA might have? The dr has suggested an intrinsic factor test to check for PA but as my levels are only just outside of the reference range, I’m thinking it may be unlikely? My serum B12 is normal at 262 ng/l, which also makes me think my symptoms probably aren’t caused by a B12 deficiency?

Also, I’ve read that PA causes tingling and numbness in fingers and toes. I do get that fairly often but it’s only when I’m also feeling cold. I get cold very easily and can get numb fingers just from sitting in someone’s unheated house for a while but am I right in thinking that with PA the numbness is unrelated to the cold, so my numbness is something different?

I’d be really grateful for any advice and experience! In some ways I’d be glad for a PA diagnosis just to have an explanation for my symptoms and to know I’m not crazy!

[fbirder]

The active B12 test is more accurate than the serum test, so I would go with that. People can be deficient, and show symptoms of the deficiency, with levels higher than yours.

I would ask for a trial of B12 injections to see if they improve your symptoms, as described in this NHS document. hey.nhs.uk/wp/wp-content/up...

[Piperh in reply to fbirder]

Thank you for the reply!

[martinec]

Check for both intrinsic factor AND parietal cell antibodies, also investigate active B12, folate, Vit D, thyroid (your cold sensitivity) as these are often cluster issues.

Iron & ferritin will also be affected if you have parietal cell antibodies (autoimmune gastritis).

The below info might help you?:

A complete blood count that will include a haematology report (RBC Indices) will help to determine a B12 deficiency. Tests included in a haematology report are;

MCV (Mean Corpuscular Volume) Reference range is usually 80 – 100 (Note, I will not use units unless necessary). This reference range was changed about 7 to 10 years ago, the range used to be 80 – 94. Older research suggests that anyone with an MCV above 94 should be checked for B12/folate deficiency. Other health disorders such as diabetes and thyroidism can also elevate the MCV level. In short, B12 deficiency/folate deficiency increases MCV. However, iron deficiency decreases the MCV so if you are B12 deficient and iron deficient, this will balance out the MCV so that it will give a normal result. If your MCV goes below 87, then you need to make sure your doctor checks Ferritin levels.

MCH - Mean Corpuscular Haemoglobin – mirrors MCV..if your level is above normal or on the high end, then this is suspicious for B12 deficiency or folate deficiency or both. If it is on the low end, this would indicate a potential iron deficiency.

MCHC - mean corpuscular haemoglobin concentration also mirrors MCV and MCH when an anaemia is present, if it sits towards the high end, this is indicative of B12 or folate deficiency, if it sits towards the the low end, this is indicative of an iron deficiency. The ferritin level would be a good indicator here if you are developing an iron deficiency.

RDW - Red cell distribution width – range is 11 to 15 % although this can vary from lab to lab, the test calculates any change in size of the red blood cells. Along with the MCV, the RDW result if high, usually means a B12/folate deficiency. However, this is not true if there is an iron deficiency because iron deficiency will also increase the RDW.

WBC - white blood cells – it is found most PA patients tend to be on the low normal end of the reference range because of autoimmune conditions.

[Piperh in reply to martinec]

Thank you very much for the advice

[Sita505USA in reply to martinec]

Hi Martinec

Can you private message me with this information or send me a link? I cannot print it from the HU site or from the email I sent it to..,

Many thanks,

Sita505